Journal Article > Commentary

Potential deterioration of older surgeons' technical performance is a patient safety concern. This guidance developed from a Society of Surgical Chairs panel discussion puts forth several steps to manage the transition of aging surgeons. Recommendations include mandatory cognitive and psychomotor testing for surgeons age 65 and older, respectful consideration of the financial and emotional concerns of aging surgeons, and lifelong mentoring around the transition from clinical to nonclinical roles. The authors anticipate that such initiatives will prompt thoughtful support for aging surgeons that ensures patient safety. In an accompanying editorial, an older physician supports mandatory testing and suggests individual-level steps to address aging as a surgeon, including healthy lifestyle and financial habits.

Journal Article > Commentary

High-risk industries like aviation employ policies to require that practitioners retire from risky work at a certain age. This commentary advocates for individual rather than general approaches to assessing abilities of aging surgeons to practice safely.

Journal Article > Review

This systematic review of the safety of overlapping surgery included 14 studies and did not find differences in 30-day mortality or overall morbidity in overlapping versus nonoverlapping surgery across a range of procedures. Researchers noted a small increase in length of procedure for overlapping surgeries. They conclude that overlapping surgery does not lead to higher risk for morbidity and mortality, despite the controversy associated with this practice.

Journal Article > Study

Although this survey of perioperative nurses, technologists, and unlicensed staff in two academic medical centers found disruptive behavior to be common, staff did not perceive any impact on patient safety, contrary to evidence. An AHRQ WebM&M commentary discussed how a physician reacted negatively after a nurse spoke up about his unsafe practice.

Journal Article > Study

This qualitative study used interviews with academic surgeons to vividly illustrate the second victim phenomenon and explore the range of emotions and coping mechanisms clinicians use after being involved in an adverse event.

Journal Article > Study

Despite the extensive publicity that checklists have received as a result of their central role in seminal patient safety programs, hospitals are increasingly recognizing that checklists are not a panacea. A qualitative analysis of the Keystone ICU project found that many factors beyond the checklist itself were central to the project's success, including development of a culture of safety. This Dutch study sought to evaluate both the uptake and the impact of the World Health Organization's surgical safety checklist at a tertiary care hospital. The investigators found that full use of the checklist was strongly associated with decreased postoperative mortality, but patients for whom the checklist was only partially completed, or not completed at all, did not derive any benefits. Cultural and implementation factors likely influence checklist usage, and organizations must consider these factors carefully when attempting to encourage use of even proven checklists.

Journal Article > Study

This study examined more than 21,000 surgical specimens and estimated a surgical specimen identification error rate of 4.3 per 1000 specimens. Error rates were higher for specimens associated with a biopsy procedure and the outpatient setting. The authors point out that specimen mislabeling represents one type of communication error and that certain strategies may prevent these events. The Joint Commission has addressed specimen labeling in their National Patient Safety Goals; the ability of hospital systems to prevent these errors may serve as a marker of quality and safety.

Journal Article > Study

Although instances of wrong-site, wrong-procedure, and wrong-patient adverse events (WSPEs) have been widely publicized, the true incidence of such errors remains unclear. A prior study indicated a rate of approximately 1 case per 112,000 surgeries, but WSPEs may occur in the outpatient setting or in ambulatory surgery as well. In this study, the authors reviewed four databases to determine the incidence of all WSPEs, including procedures performed outside the operating room. Data from both mandatory and voluntary reporting systems indicates that approximately 1300 to 2700 WSPEs occur yearly, with many occurring during outpatient procedures. The authors argue that all WSPEs should be considered preventable, and recommend reporting and prevention standards for reducing such errors.

This study discovered both similarities and differences in the way surgeons, nurses, anesthesiologists, and patients responded to four scripted clinical error scenarios. Findings suggested that all groups incorporated a negative outcome or a deviation from standard of practice into their error definition rather than analyzing the event independent of those factors. In addition, noted differences existed between patients who supported reporting for all negative events and nurses who believed in selective reporting. Similarly, persistent gaps existed between the full disclosure patients expect and the partial disclosure health professionals believe should occur. While the study represents a small sample size from two tertiary institutions, it does emphasize the importance of a safety culture and the need to redefine errors as opportunities for learning and improvement rather than individual or isolated events.

Journal Article > Study

Investigators implemented a training program that used crew resource management and organizational change principles to improve communication in the operating room. Preoperative briefings significantly improved communication between surgeons and anesthesiologists.